Requesting a Genomic Test for Solid Tumours
The South West Genomic Laboratory Hub (SWGLH) offers the following genomic tests for patients with solid tumours, neurological tumours, sarcoma and paediatric tumours in:
- Gene panels, FISH and direct mutation tests for solid tumours, neurological tumours, sarcoma and paediatric tumours including lymphoma. Follow the sequential steps on this page below.
- Whole genome sequencing for any solid tumour in the young (<20 years) or sarcoma: Please see page requesting a whole genome sequencing test
Step 1 Check patient eligibility
- Eligible tumours and the available tests are shown in the National Genomic Test Directory for Cancer (NGTD) Only tests specified by the National Genomic Test Directory are funded, please note the M-code for the required investigation.
- Genomic testing for tumours is rapidly advancing. The SWGLH is implementing new technologies such as a large gene panel test that detect single nucleotide changes, copy number changes, and gene fusions. The strategy aims to provide timely results for multiple tumour types that are relevant for clinical care and entry into trials.
Step 2 Collect the sample(s)
- Gene panel and direct mutation tests will be performed on FFPE samples obtained at biopsy or surgical resection, or from cytology samples
- Samples should be prepared by the local Pathology lab and forwarded to the SWGLH with minimal delay.
- The Pathologist’s assessment of neoplastic cell content of the sample is essential to ensure suitability for genomic testing.
- Sample requirements as follows:
- For DNA or RNA extraction only
- Sample with >20% neoplastic cells: send one tube (Eppendorf or Universal): containing 5 x 10µm sections (curls/scrolls)
- OR Sample with <20% neoplastic cells: send 10 x 5µm slide mounted sections along with H&E with regions of >20% neoplastic cells highlighted.
- For DNA and RNA extraction
- Sample with >20% neoplastic cells: send two tubes (Eppendorf or Universal): each containing 5 x 10µm sections (curls/scrolls)
- Sample with <20% neoplastic cells: send 20 x 5µm slide mounted sections along with H&E with regions of >20% neoplastic cells highlighted.
- For FISH
- Please send 2 x 4µm and 2 x 2µm sections on 'APES' or 'sticky' slides per test required with an accompanying H&E slide with the appropriate tumour rich area(s) marked.
- For DNA or RNA extraction only
- Indication M4.5 Blood samples for circulating tumour DNA analysis should be sent directly by the referring clinician to the Bristol Genetics Laboratory.
- Further information in the form of SWGLH guidance documents for Clinician's and Pathologists can be found in the blocks on the right hand side of this page
Step 3 Complete the request form
- In the instance of a Sarcoma please use this request form
- All samples for genomic testing for non-haematological tumours should be accompanied by a fully completed SWGLH
- The M-code should be included to identify which test is required.
- The request form should clearly state who the report should be sent to. Reports will be issued by email. Multiple email addresses may be included (e.g. the referring clinician, pathologist, and MDT coordinator)
- The request should be sent to your local Pathology lab to activate the preparation of samples for genomic testing.
Step 4 Transportation of sample and request form to the SWGLH
- As soon as possible after local processing and assessment, samples should be transported rapidly to the SWGLH (Bristol Genetics Laboratory) using one of the rapid transport routes that have been established from all SW Trusts
- Download a copy of the transport guide
Step 5 What are the turnaround times for the test?
- We aim to report gene panel tests within 7-10 working days of sample receipt at the SWGLH to help ensure that results available to clinicians to guide selection of treatment for cancer.
- When special circumstances require a more urgent result, a rapid single gene test may be performed instead of a gene panel. Clinicians or Pathologists should contact the Bristol Genetics laboratory directly to access this service.
Step 6 How will the result be returned?
- The genomic report will be returned to the requestor’s email indicated on the test request form. We recommend that this should be a generic continuously monitored email address.
- The SWGLH genomic report for cancer will describe findings only in genes that are clinically relevant for the specific tumour sub-type.
- The report will also indicate standard of care (NICE approved) treatment. For the infrequent cases that require further discussion, genomic test results will be discussed at SW GLH Genomics Tumour Advisory Board meetings (GTAB), held by Webex.